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3. Vastuullisuusluokitusten rooli tilintarkastuksen palkkioiden määräytymisessä

Author

Turpeinen, M. (Mikke) and Turpeinen, M. (Mikke)

Abstract

Tiivistelmä. Tämän tutkimuksen periaatteellisena tavoitteena on tutkia vastuullisuusluokitusten ja tilintarkastuksen palkkioiden suhdetta toisiinsa. Tämän lisäksi tutkimuksessa tulkittiin vastuullisuusraportoinnin laadun merkitystä edellä mainittuun selitettävään muuttujaan eli tilintarkastuksen palkkioihin näiden kummankin kuvatessa tilintarkastuskohteen vastuullisuutta eriävällä laajuudella. Tutkimusta keskittyen edellä mainittujen muuttujien suhteeseen verrattuna tilintarkastuksen palkkioihin ei ole ollut merkittävästi, joten tutkimus tuo vastuullisuusraportointiin ja tilintarkastuksen palkkioihin keskittyneeseen tutkimukseen uutta näkökulmaa. Tutkimusaineistona toimi joukko suomalaisia julkisia ja yksityisiä yrityksiä sekä niiden tilinpäätöksiä aikaväliltä 2012–2021, joihin liittyvää dataa kerättiin hyödyntämällä Refinitivin tietokantoja ja erityisesti vastuullisuusdataa sisältävää Asset4 tietokantaa. Tutkimuksessa hyödynnettiin tutkimusmetodina usean muuttujan regressioanalyysia, jolloin oli mahdollista arvioida useamman muuttujan roolia ja selittävyyttä yhtä aikaa suhteessa tilintarkastuksen palkkioihin. Sekä vastuullisuusluokitusten että vastuullisuusraportoinnin laadun suhteen tuotettiin omat regressiot, joissa ne olivat yhtälössä kokeellisina selittävinä muuttujina. Tutkimuksessa hyödynnettiin laaja-alaisesti aiemmissa tutkimuksissa merkitseviksi tilintarkastuksen palkkioiden suhteen nähtyjä kontrollimuuttujia. Näistä saatujen tulosten pohjalta pyrittiin vastaamaan tutkimuksessa nostettuun avustavaan tutkimuskysymykseen, jossa arvioitiin syitä vastuullisuusluokitusten ja tilintarkastuksen palkkioiden suhteen takana tai miksi kyseistä suhdetta ei ole tuloksissa nähtävissä. Tutkimuksen tulokset viittaavat, että vastuullisuusluokitusten ja tilintarkastuksen palkkioiden välillä on nähtävissä lievä mutta merkitsevä positiivinen suhde. Regressioiden tulosten mukaan yhden yksikön muutos vastuullisuusluokituksissa näkyisi yhden prosentin muutoksena tilintarkastukse

Published
2023

4. Reporting of costs and economic impacts in randomized trials of de-implementation interventions for low-value care:a systematic scoping review

Author

Falkenbach, P. (Petra), Raudasoja, A. J. (Aleksi J.), Vernooij, R. W. (Robin W. M.), Mustonen, J. M. (Jussi M. J.), Agarwal, A. (Arnav), Aoki, Y. (Yoshitaka), Blanker, M. H. (Marco H.), Cartwright, R. (Rufus), Garcia-Perdomo, H. A. (Herney A.), Kilpeläinen, T. P. (Tuomas P.), Lainiala, O. (Olli), Lamberg, T. (Tiina), Nevalainen, O. P. (Olli P. O.), Raittio, E. (Eero), Richard, P. O. (Patrick O.), Violette, P. D. (Philippe D.), Tikkinen, K. A. (Kari A. O.), Sipilä, R. (Raija), Turpeinen, M. (Miia), Komulainen, J. (Jorma), Falkenbach, P. (Petra), Raudasoja, A. J. (Aleksi J.), Vernooij, R. W. (Robin W. M.), Mustonen, J. M. (Jussi M. J.), Agarwal, A. (Arnav), Aoki, Y. (Yoshitaka), Blanker, M. H. (Marco H.), Cartwright, R. (Rufus), Garcia-Perdomo, H. A. (Herney A.), Kilpeläinen, T. P. (Tuomas P.), Lainiala, O. (Olli), Lamberg, T. (Tiina), Nevalainen, O. P. (Olli P. O.), Raittio, E. (Eero), Richard, P. O. (Patrick O.), Violette, P. D. (Philippe D.), Tikkinen, K. A. (Kari A. O.), Sipilä, R. (Raija), Turpeinen, M. (Miia), and Komulainen, J. (Jorma)

Abstract

Background: De-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research. Methods: We searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool. Results: We screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly conducted in North America (36%) or Europe (32%) and in the primary care context (70%). The most common practice of interest was reduction in the use of antibiotics or other medications (74%). Most studies used education strategies (meetings, materials) (64%). Studies used either a single strategy (52%) or were multifaceted (48%). Of the 227 eligible studies, 18 (8%) reported on direct costs of the used de-implementation strategy; of which, 13 reported total costs, and 12 reported per unit costs (7 reported both). The costs of de-implementation strategies varied considerably. Of the 227 eligible studies, 43 (19%) reported on impact of de-implementation on health care costs. Health care costs decreased in 27 studies (63%), increased in 2 (5%), and were unchanged in 14 (33%). Conclusion: De-implementation randomized controlled trials typically did not report direct costs of the de-implementation strategies (92%) or the impacts of de-implementation on health care costs (81%). Lack of cost information may limit the value of de-implementation trials to decision-maker

Published
2023

5. New insights into the genetic etiology of Alzheimer's disease and related dementias

Author

Bellenguez, C., Küçükali, F., Jansen, I. E., Kleineidam, L., Moreno-Grau, S., Amin, N., Naj, A. C., Campos-Martin, R., Grenier-Boley, B., Andrade, V., Holmans, P. A., Boland, A., Damotte, V., van der Lee, S. J., Costa, M. R., Kuulasmaa, T., Yang, Q., de Rojas, I., Bis, J. C., Yaqub, A., Prokic, I., Chapuis, J., Ahmad, S., Giedraitis, V., Aarsland, D., Garcia-Gonzalez, P., Abdelnour, C., Alarcón-Martín, E., Alcolea, D., Alegret, M., Alvarez, I., Álvarez, V., Armstrong, N. J., Tsolaki, A., Antúnez, C., Appollonio, I., Arcaro, M., Archetti, S., Pastor, A. A., Arosio, B., Athanasiu, L., Bailly, H., Banaj, N., Baquero, M., Barral, S., Beiser, A., Pastor, A. B., Below, J. E., Benchek, P., Benussi, L., Berr, C., Besse, C., Bessi, V., Binetti, G., Bizarro, A., Blesa, R., Boada, M., Boerwinkle, E., Borroni, B., Boschi, S., Bossù, P., Bråthen, G., Bressler, J., Bresner, C., Brodaty, H., Brookes, K. J., Brusco, L. I., Buiza-Rueda, D., Bûrger, K., Burholt, V., Bush, W. S., Calero, M., Cantwell, L. B., Chene, G., Chung, J., Cuccaro, M. L., Carracedo, Á., Cecchetti, R., Cervera-Carles, L., Charbonnier, C., Chen, H. -H., Chillotti, C., Ciccone, S., Claassen, J. A. H. R., Clark, C., Conti, E., Corma-Gómez, A., Costantini, E., Custodero, C., Daian, D., Dalmasso, M. C., Daniele, A., Dardiotis, E., Dartigues, J. -F., de Deyn, P. P., de Paiva Lopes, K., de Witte, L. D., Debette, S., Deckert, J., del Ser, T., Denning, N., Destefano, A., Dichgans, M., Diehl-Schmid, J., Diez-Fairen, M., Rossi, P. D., Djurovic, S., Duron, E., Düzel, E., Dufouil, C., Eiriksdottir, G., Engelborghs, S., Escott-Price, V., Espinosa, A., Ewers, M., Faber, K. M., Fabrizio, T., Nielsen, S. F., Fardo, D. W., Farotti, L., Fenoglio, C., Fernández-Fuertes, M., Ferrari, R., Ferreira, C. B., Ferri, E., Fin, B., Fischer, P., Fladby, T., Fließbach, K., Fongang, B., Fornage, M., Fortea, J., Foroud, T. M., Fostinelli, S., Fox, N. C., Franco-Macías, E., Bullido, M. J., Frank-García, A., Froelich, L., Fulton-Howard, B., Galimberti, D., García-Alberca, J. M., García-González, P., Garcia-Madrona, S., Garcia-Ribas, G., Ghidoni, R., Giegling, I., Giorgio, G., Goate, A. M., Goldhardt, O., Gomez-Fonseca, D., González-Pérez, A., Graff, C., Grande, G., Green, E., Grimmer, T., Grünblatt, E., Grunin, M., Gudnason, V., Guetta-Baranes, T., Haapasalo, A., Hadjigeorgiou, G., Haines, J. L., Hamilton-Nelson, K. L., Hampel, H., Hanon, O., Hardy, J., Hartmann, A. M., Hausner, L., Harwood, J., Heilmann-Heimbach, S., Helisalmi, S., Heneka, M. T., Hernández, I., Herrmann, M. J., Hoffmann, P., Holmes, C., Holstege, H., Vilas, R. H., Hulsman, M., Humphrey, J., Biessels, G. J., Jian, X., Johansson, C., Jun, G. R., Kastumata, Y., Kauwe, J., Kehoe, P. G., Kilander, L., Ståhlbom, A. K., Kivipelto, M., Koivisto, A., Kornhuber, J., Kosmidis, M. H., Kukull, W. A., Kuksa, P. P., Kunkle, B. W., Kuzma, A. B., Lage, C., Laukka, E. J., Launer, L., Lauria, A., Lee, C. -Y., Lehtisalo, J., Lerch, O., Lleó, A., Longstreth, W., Lopez, O., de Munain, A. L., Love, S., Löwemark, M., Luckcuck, L., Lunetta, K. L., Ma, Y., Macías, J., Macleod, C. A., Maier, W., Mangialasche, F., Spallazzi, M., Marquié, M., Marshall, R., Martin, E. R., Montes, A. M., Rodríguez, C. M., Masullo, C., Mayeux, R., Mead, S., Mecocci, P., Medina, M., Meggy, A., Mehrabian, S., Mendoza, S., Menéndez-González, M., Mir, P., Moebus, S., Mol, M., Molina-Porcel, L., Montrreal, L., Morelli, L., Moreno, F., Morgan, K., Mosley, T., Nöthen, M. M., Muchnik, C., Mukherjee, S., Nacmias, B., Ngandu, T., Nicolas, G., Nordestgaard, B. G., Olaso, R., Orellana, A., Orsini, M., Ortega, G., Padovani, A., Paolo, C., Papenberg, G., Parnetti, L., Pasquier, F., Pastor, P., Peloso, G., Pérez-Cordón, A., Pérez-Tur, J., Pericard, P., Peters, O., Pijnenburg, Y. A. L., Pineda, J. A., Piñol-Ripoll, G., Pisanu, C., Polak, T., Popp, J., Posthuma, D., Priller, J., Puerta, R., Quenez, O., Quintela, I., Thomassen, J. Q., Rábano, A., Rainero, I., Rajabli, F., Ramakers, I., Real, L. M., Reinders, M. J. T., Reitz, C., Reyes-Dumeyer, D., Ridge, P., Riedel-Heller, S., Riederer, P., Roberto, N., Rodriguez-Rodriguez, E., Rongve, A., Allende, I. R., Rosende-Roca, M., Royo, J. L., Rubino, E., Rujescu, D., Sáez, M. E., Sakka, P., Saltvedt, I., Sanabria, Á., Sánchez-Arjona, M. B., Sanchez-Garcia, F., Juan, P. S., Sánchez-Valle, R., Sando, S. B., Sarnowski, C., Satizabal, C. L., Scamosci, M., Scarmeas, N., Scarpini, E., Scheltens, P., Scherbaum, N., Scherer, M., Schmid, M., Schneider, A., Schott, J. M., Selbæk, G., Seripa, D., Serrano, M., Sha, J., Shadrin, A. A., Skrobot, O., Slifer, S., Snijders, G. J. L., Soininen, H., Solfrizzi, V., Solomon, A., Song, Y. E., Sorbi, S., Sotolongo-Grau, O., Spalletta, G., Spottke, A., Squassina, A., Stordal, E., Tartan, J. P., Tárraga, L., Tesí, N., Thalamuthu, A., Thomas, T., Tosto, G., Traykov, L., Tremolizzo, L., Tybjærg-Hansen, A., Uitterlinden, A., Ullgren, A., Ulstein, I., Valero, S., Valladares, O., Broeckhoven, C. V., Vance, J., Vardarajan, B. N., van der Lugt, A., Dongen, J. V., van Rooij, J., van Swieten, J., Vandenberghe, R., Verhey, F., Vidal, J. -S., Vogelgsang, J., Vyhnalek, M., Wagner, M., Wallon, D., Wang, L. -S., Wang, R., Weinhold, L., Wiltfang, J., Windle, G., Woods, B., Yannakoulia, M., Zare, H., Zhao, Y., Zhang, X., Zhu, C., Zulaica, M., Laczo, J., Matoska, V., Serpente, M., Assogna, F., Piras, F., Ciullo, V., Shofany, J., Ferrarese, C., Andreoni, S., Sala, G., Zoia, C. P., Zompo, M. D., Benussi, A., Bastiani, P., Takalo, M., Natunen, T., Laatikainen, T., Tuomilehto, J., Antikainen, R., Strandberg, T., Lindström, J., Peltonen, M., Abraham, R., Al-Chalabi, A., Bass, N. J., Brayne, C., Brown, K. S., Collinge, J., Craig, D., Deloukas, P., Fox, N., Gerrish, A., Gill, M., Gwilliam, R., Harold, D., Hollingworth, P., Johnston, J. A., Jones, L., Lawlor, B., Livingston, G., Lovestone, S., Lupton, M., Lynch, A., Mann, D., Mcguinness, B., Mcquillin, A., O’Donovan, M. C., Owen, M. J., Passmore, P., Powell, J. F., Proitsi, P., Rossor, M., Shaw, C. E., Smith, A. D., Gurling, H., Todd, S., Mummery, C., Ryan, N., Lacidogna, G., Adarmes-Gómez, A., Mauleón, A., Pancho, A., Gailhajenet, A., Lafuente, A., Macias-García, D., Martín, E., Pelejà, E., Carrillo, F., Merlín, I. S., Garrote-Espina, L., Vargas, L., Carrion-Claro, M., Marín, M., Labrador, M., Buendia, M., Alonso, M. D., Guitart, M., Moreno, M., Ibarria, M., Periñán, M., Aguilera, N., Gómez-Garre, P., Cañabate, P., Escuela, R., Pineda-Sánchez, R., Vigo-Ortega, R., Jesús, S., Preckler, S., Rodrigo-Herrero, S., Diego, S., Vacca, A., Roveta, F., Salvadori, N., Chipi, E., Boecker, H., Laske, C., Perneczky, R., Anastasiou, C., Janowitz, D., Malik, R., Anastasiou, A., Parveen, K., López-García, S., Antonell, A., Mihova, K. Y., Belezhanska, D., Weber, H., Kochen, S., Solis, P., Medel, N., Lisso, J., Sevillano, Z., Politis, D. G., Cores, V., Cuesta, C., Ortiz, C., Bacha, J. I., Rios, M., Saenz, A., Abalos, M. S., Kohler, E., Palacio, D. L., Etchepareborda, I., Kohler, M., Novack, G., Prestia, F. A., Galeano, P., Castaño, E. M., Germani, S., Toso, C. R., Rojo, M., Ingino, C., Mangone, C., Rubinsztein, D. C., Teipel, S., Fievet, N., Deramerourt, V., Forsell, C., Thonberg, H., Bjerke, M., Roeck, E. D., Martínez-Larrad, M. T., Olivar, N., Cano, A., Macias, J., Maroñas, O., Nuñez-Llaves, R., Olivé, C., Adarmes-Gómez, A. D., Amer-Ferrer, G., Antequera, M., Burguera, J. A., Casajeros, M. J., Martinez de Pancorbo, M., Hevilla, S., Espinosa, M. A. L., Legaz, A., Manzanares, S., Marín-Muñoz, J., Marín, T., Martínez, B., Martínez, V., Martínez-Lage Álvarez, P., Iriarte, M. M., Periñán-Tocino, M. T., Real de Asúa, D., Rodrigo, S., Sastre, I., Vicente, M. P., Vivancos, L., Epelbaum, J., Hannequin, D., Campion, D., Deramecourt, V., Tzourio, C., Brice, A., Dubois, B., Williams, A., Thomas, C., Davies, C., Nash, W., Dowzell, K., Morales, A. C., Bernardo-Harrington, M., Turton, J., Lord, J., Brown, K., Vardy, E., Fisher, E., Warren, J. D., Ryan, N. S., Guerreiro, R., Uphill, J., Bass, N., Heun, R., Kölsch, H., Schürmann, B., Lacour, A., Herold, C., Powell, J., Patel, Y., Hodges, A., Becker, T., Warden, D., Wilcock, G., Clarke, R., Ben-Shlomo, Y., Hooper, N. M., Pickering-Brown, S., Sussams, R., Warner, N., Bayer, A., Heuser, I., Drichel, D., Klopp, N., Mayhaus, M., Riemenschneider, M., Pinchler, S., Feulner, T., Gu, W., van den Bussche, H., Hüll, M., Frölich, L., Wichmann, H. -E., Jöckel, K. -H., O’Donovan, M., Owen, M., Bahrami, S., Bosnes, I., Selnes, P., Bergh, S., Palotie, A., Daly, M., Jacob, H., Matakidou, A., Runz, H., John, S., Plenge, R., Mccarthy, M., Hunkapiller, J., Ehm, M., Waterworth, D., Fox, C., Malarstig, A., Klinger, K., Call, K., Behrens, T., Loerch, P., Mäkelä, T., Kaprio, J., Virolainen, P., Pulkki, K., Kilpi, T., Perola, M., Partanen, J., Pitkäranta, A., Kaarteenaho, R., Vainio, S., Turpeinen, M., Serpi, R., Laitinen, T., Mäkelä, J., Kosma, V. -M., Kujala, U., Tuovila, O., Hendolin, M., Pakkanen, R., Waring, J., Riley-Gillis, B., Liu, J., Biswas, S., Diogo, D., Marshall, C., Hu, X., Gossel, M., Graham, R., Cummings, B., Ripatti, S., Schleutker, J., Arvas, M., Carpén, O., Hinttala, R., Kettunen, J., Mannermaa, A., Laukkanen, J., Julkunen, V., Remes, A., Kälviäinen, R., Peltola, J., Tienari, P., Rinne, J., Ziemann, A., Esmaeeli, S., Smaoui, N., Lehtonen, A., Eaton, S., Lahdenperä, S., van Adelsberg, J., Michon, J., Kerchner, G., Bowers, N., Teng, E., Eicher, J., Mehta, V., Gormley, P., Linden, K., Whelan, C., Xu, F., Pulford, D., Färkkilä, M., Pikkarainen, S., Jussila, A., Blomster, T., Kiviniemi, M., Voutilainen, M., Georgantas, B., Heap, G., Rahimov, F., Usiskin, K., Lu, T., Oh, D., Kalpala, K., Miller, M., Mccarthy, L., Eklund, K., Palomäki, A., Isomäki, P., Pirilä, L., Kaipiainen-Seppänen, O., Huhtakangas, J., Lertratanakul, A., Hochfeld, M., Bing, N., Gordillo, J. E., Mars, N., Pelkonen, M., Kauppi, P., Kankaanranta, H., Harju, T., Close, D., Greenberg, S., Chen, H., Betts, J., Ghosh, S., Salomaa, V., Niiranen, T., Juonala, M., Metsärinne, K., Kähönen, M., Junttila, J., Laakso, M., Pihlajamäki, J., Sinisalo, J., Taskinen, M. -R., Tuomi, T., Challis, B., Peterson, A., Chu, A., Parkkinen, J., Muslin, A., Joensuu, H., Meretoja, T., Aaltonen, L., Mattson, J., Auranen, A., Karihtala, P., Kauppila, S., Auvinen, P., Elenius, K., Popovic, R., Schutzman, J., Loboda, A., Chhibber, A., Lehtonen, H., Mcdonough, S., Crohns, M., Kulkarni, D., Kaarniranta, K., Turunen, J. A., Ollila, T., Seitsonen, S., Uusitalo, H., Aaltonen, V., Uusitalo-Järvinen, H., Luodonpää, M., Hautala, N., Loomis, S., Strauss, E., Podgornaia, A., Hoffman, J., Tasanen, K., Huilaja, L., Hannula-Jouppi, K., Salmi, T., Peltonen, S., Koulu, L., Harvima, I., Wu, Y., Choy, D., Pussinen, P., Salminen, A., Salo, T., Rice, D., Nieminen, P., Palotie, U., Siponen, M., Suominen, L., Mäntylä, P., Gursoy, U., Anttonen, V., Sipilä, K., Davis, J. W., Quarless, D., Petrovski, S., Wigmore, E., Chen, C. -Y., Bronson, P., Tsai, E., Huang, Y., Maranville, J., Shaikho, E., Mohammed, E., Wadhawan, S., Kvikstad, E., Caliskan, M., Chang, D., Bhangale, T., Pendergrass, S., Holzinger, E., Chen, X., Hedman, Å., King, K. S., Wang, C., Xu, E., Auge, F., Chatelain, C., Rajpal, D., Liu, D., Xia, T. -H., Brauer, M., Kurki, M., Karjalainen, J., Havulinna, A., Jalanko, A., Palta, P., della Briotta Parolo, P., Zhou, W., Lemmelä, S., Rivas, M., Harju, J., Lehisto, A., Ganna, A., Llorens, V., Laivuori, H., Rüeger, S., Niemi, M. E., Tukiainen, T., Reeve, M. P., Heyne, H., Palin, K., Garcia-Tabuenca, J., Siirtola, H., Kiiskinen, T., Lee, J., Tsuo, K., Elliott, A., Kristiansson, K., Hyvärinen, K., Ritari, J., Koskinen, M., Pylkäs, K., Kalaoja, M., Karjalainen, M., Mantere, T., Kangasniemi, E., Heikkinen, S., Laakkonen, E., Sipeky, C., Heron, S., Karlsson, A., Jambulingam, D., Rathinakannan, V. S., Kajanne, R., Aavikko, M., Jiménez, M. G., della Briotta Parola, P., Kanai, M., Kaunisto, M., Kilpeläinen, E., Sipilä, T. P., Brein, G., Awaisa, G., Shcherban, A., Donner, K., Loukola, A., Laiho, P., Sistonen, T., Kaiharju, E., Laukkanen, M., Järvensivu, E., Lähteenmäki, S., Männikkö, L., Wong, R., Mattsson, H., Hiekkalinna, T., Paajanen, T., Pärn, K., Gracia-Tabuenca, J., Abner, E., Adams, P. M., Aguirre, A., Albert, M. S., Albin, R. L., Allen, M., Alvarez, L., Apostolova, L. G., Arnold, S. E., Asthana, S., Atwood, C. S., Ayres, G., Baldwin, C. T., Barber, R. C., Barnes, L. L., Beach, T. G., Becker, J. T., Beecham, G. W., Beekly, D., Benitez, B. A., Bennett, D., Bertelson, J., Margaret, F. E., Bird, T. D., Blacker, D., Boeve, B. F., Bowen, J. D., Boxer, A., Brewer, J., Burke, J. R., Burns, J. M., Buxbaum, J. D., Cairns, N. J., Cao, C., Carlson, C. S., Carlsson, C. M., Carney, R. M., Carrasquillo, M. M., Chasse, S., Chesselet, M. -F., Chesi, A., Chin, N. A., Chui, H. C., Craft, S., Crane, P. K., Cribbs, D. H., Crocco, E. A., Cruchaga, C., Cullum, M., Darby, E., Davis, B., De Jager, P. L., Decarli, C., Detoledo, J., Dick, M., Dickson, D. W., Dombroski, B. A., Doody, R. S., Duara, R., Ertekin-Taner, N., Evans, D. A., Fairchild, T. J., Fallon, K. B., Farlow, M. R., Farrell, J. J., Fernandez-Hernandez, V., Ferris, S., Frosch, M. P., Galasko, D. R., Gamboa, A., Gearing, M., Geschwind, D. H., Ghetti, B., Gilbert, J. R., Grabowski, T. J., Graff-Radford, N. R., Grant, S. F. A., Green, R. C., Growdon, J. H., Hakonarson, H., Hall, J., Hamilton, R. L., Harari, O., Harrell, L. E., Haut, J., Head, E., Henderson, V. W., Hernandez, M., Hohman, T., Honig, L. S., Huebinger, R. M., Huentelman, M. J., Hulette, C. M., Hyman, B. T., Hynan, L. S., Ibanez, L., Jarvik, G. P., Jayadev, S., Jin, L. -W., Johnson, K., Johnson, L., Kamboh, M. I., Karydas, A. M., Katz, M. J., Kaye, J. A., Keene, C. D., Khaleeq, A., Kim, R., Knebl, J., Kowall, N. W., Kramer, J. H., Laferla, F. M., Lah, J. J., Larson, E. B., Lee, E. B., Lerner, A., Leung, Y. Y., Leverenz, J. B., Levey, A. 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Aarsland, D, Garcia-Gonzalez, P, Abdelnour, C, Alarcón-Martín, E, Alcolea, D, Alegret, M, Alvarez, I, Álvarez, V, Armstrong, N, Tsolaki, A, Antúnez, C, Appollonio, I, Arcaro, M, Archetti, S, Pastor, A, Arosio, B, Athanasiu, L, Bailly, H, Banaj, N, Baquero, M, Barral, S, Beiser, A, Below, J, Benchek, P, Benussi, L, Berr, C, Besse, C, Bessi, V, Binetti, G, Bizarro, A, Blesa, R, Boada, M, Boerwinkle, E, Borroni, B, Boschi, S, Bossù, P, Bråthen, G, Bressler, J, Bresner, C, Brodaty, H, Brookes, K, Brusco, L, Buiza-Rueda, D, Bûrger, K, Burholt, V, Bush, W, Calero, M, Cantwell, L, Chene, G, Chung, J, Cuccaro, M, Carracedo, Á, Cecchetti, R, Cervera-Carles, L, Charbonnier, C, Chen, H, Chillotti, C, Ciccone, S, Claassen, J, Clark, C, Conti, E, Corma-Gómez, A, Costantini, E, Custodero, C, Daian, D, Dalmasso, M, Daniele, A, Dardiotis, E, Dartigues, J, de Deyn, P, de Paiva Lopes, K, de Witte, L, Debette, S, Deckert, J, Del Ser, T, Denning, N, Destefano, A, Dichgans, M, Diehl-Schmid, J, Diez-Fairen, 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Uitterlinden, A, Ullgren, A, Ulstein, I, Valero, S, Valladares, O, Broeckhoven, C, Vance, J, Vardarajan, B, van der Lugt, A, Dongen, J, van Rooij, J, van Swieten, J, Vandenberghe, R, Verhey, F, Vidal, J, Vogelgsang, J, Vyhnalek, M, Wagner, M, Wallon, D, Wang, L, Wang, R, Weinhold, L, Wiltfang, J, Windle, G, Woods, B, Yannakoulia, M, Zare, H, Zhao, Y, Zhang, X, Zhu, C, Zulaica, M, Andreoni, S, Ferrarese, C, Sala, G, Zoia, C, Farrer, L, Psaty, B, Ghanbari, M, Raj, T, Sachdev, P, Mather, K, Jessen, F, Ikram, M, de Mendonça, A, Hort, J, Tsolaki, M, Pericak-Vance, M, Amouyel, P, Williams, J, Frikke-Schmidt, R, Clarimon, J, Deleuze, J, Rossi, G, Seshadri, S, Andreassen, O, Ingelsson, M, Hiltunen, M, Sleegers, K, Schellenberg, G, van Duijn, C, Sims, R, van der Flier, W, Ruiz, A, Ramirez, A, Lambert, J, VU University medical center, Amsterdam Neuroscience - Neurodegeneration, Neurology, Human genetics, Amsterdam Neuroscience - Complex Trait Genetics, Amsterdam Neuroscience - Compulsivity, 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Sachdev, Perminder [0000-0002-9595-3220], Mather, Karen [0000-0003-4143-8941], Ikram, M Arfan [0000-0003-0372-8585], Tsolaki, Magda [0000-0002-2072-8010], Pericak-Vance, Margaret A [0000-0001-7283-8804], Amouyel, Philippe [0000-0001-9088-234X], Williams, Julie [0000-0002-4069-0259], Frikke-Schmidt, Ruth [0000-0003-4084-5027], Seshadri, Sudha [0000-0001-6135-2622], Andreassen, Ole A [0000-0002-4461-3568], Sleegers, Kristel [0000-0002-0283-2332], van Duijn, Cornelia M [0000-0002-2374-9204], Sims, Rebecca [0000-0002-3885-1199], van der Flier, Wiesje M [0000-0001-8766-6224], Ramirez, Alfredo [0000-0003-4991-763X], Lambert, Jean-Charles [0000-0003-0829-7817], Apollo - University of Cambridge Repository, Complex Trait Genetics, Clinical sciences, Neuroprotection & Neuromodulation, Pathologic Biochemistry and Physiology, Clinical Biology, Epidemiology, Internal Medicine, Psychiatrie & Neuropsychologie, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA Med Staf Spec Psychiatrie (9), UAM. Departamento de Biología Molecular, University of Helsinki, Department of Neurosciences, HUS Internal Medicine and Rehabilitation, Timo Strandberg / Principal Investigator, Department of Medicine, Clinicum, HUS Neurocenter, Neurologian yksikkö, Centre of Excellence in Complex Disease Genetics, HUS Abdominal Center, Institut Pasteur, Institut National de la Santé et de la Recherche Médicale (France), European Commission, LabEx DISTALZ, Pérez-Tur, Jordi, University Children’s Hospital Basel (Suiza), INSERM (Francia), Lille Métropole Communauté Urbaine, Government of France (Francia), EADB, GR@ACE, DEGESCO, EADI, GERAD, Demgene, FinnGen, ADGC, CHARGE, Holmans, Peter A. [0000-0003-0870-9412], van der Lee, Sven J. [0000-0003-1606-8643], Costa, Marcos R. [0000-0002-4928-2163], Bis, Joshua C. [0000-0002-3409-1110], Brookes, Keeley J. [0000-0003-2427-2513], Bush, William S. [0000-0002-9729-6519], de Witte, Lot D. [0000-0002-7235-9958], del Ser, Teodoro [0000-0001-9806-7083], Fox, Nick C. [0000-0002-6660-657X], Bullido, María J. [0000-0002-6477-1117], Goate, Alison M. [0000-0002-0576-2472], Herrmann, Martin J. [0000-0001-9970-2122], Jun, Gyungah R. [0000-0002-3230-8697], Kehoe, Patrick G. [0000-0002-7542-1139], Kosmidis, Mary H. [0000-0001-8790-1220], Lunetta, Kathryn L. [0000-0002-9268-810X], MacLeod, Catherine A. [0000-0002-9314-7380], Nöthen, Markus M. [0000-0002-8770-2464], Nordestgaard, Børge G. [0000-0002-1954-7220], Pineda, Juan A. [0000-0002-3751-0296], Real, Luis M. [0000-0003-4932-7429], Reinders, Marcel J. T. [0000-0002-1148-1562], Satizabal, Claudia L. [0000-0002-1115-4430], Schott, Jonathan M. [0000-0003-2059-024X], Shadrin, Alexey A. [0000-0002-7467-250X], Farrer, Lindsay A. [0000-0001-5533-4225], Psaty, Bruce M. [0000-0002-7278-2190], Ikram, M. Arfan [0000-0003-0372-8585], Pericak-Vance, Margaret A. [0000-0001-7283-8804], Andreassen, Ole A. [0000-0002-4461-3568], van Duijn, Cornelia M. [0000-0002-2374-9204], van der Flier, Wiesje M. [0000-0001-8766-6224], and Molecular Neuroscience and Ageing Research (MOLAR)

Subjects
tau Proteins/genetics, Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1], Neurologi, MED/03 - GENETICA MEDICA, 45/43, Medizin, Stress-related disorders Donders Center for Medical Neuroscience [Radboudumc 13], genetics [Alzheimer Disease], Genome-Wide Association Study, Humans, tau Proteins, Alzheimer Disease, Cognitive Dysfunction, VARIANTS, pathology [Alzheimer Disease], Tau Proteins, Settore BIO/13 - Biologia Applicata, Cognitive Dysfunction/psychology, 692/699/375/365/1283, IMPUTATION, article, 1184 Genetics, developmental biology, physiology, Biología y Biomedicina / Biología, AMYLOID-BETA, Settore MED/26 - NEUROLOGIA, Neurology, psychology [Cognitive Dysfunction], Medical Genetics, Human, Neuroscience(all), 631/208/205/2138, All institutes and research themes of the Radboud University Medical Center, SDG 3 - Good Health and Well-being, ddc:570, Genetics, Genetic Predisposition to Disease, GENOME-WIDE ASSOCIATION, METAANALYSIS, Medicinsk genetik, MED/26 - NEUROLOGIA, Alzheimer Disease/genetics, neurology, tau Protein, NECROSIS-FACTOR-ALPHA, RISK LOCI, genetics [tau Proteins], PREDICTION MODELS, Human medicine, GENERATION, RESPONSES
Abstract

25 páginas, 6 figuras, 2 tablas, Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele., This work was funded by a grant (EADB) from the EU Joint Programme – Neurodegenerative Disease Research. INSERM UMR1167 is also funded by the INSERM, Institut Pasteur de Lille, Lille Métropole Communauté Urbaine and French government’s LABEX DISTALZ program (development of innovative strategies for a transdisciplinary approach to AD). Full consortium acknowledgements and funding are in the Supplementary Not

Published
2022
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7. Characteristics and predictors of off-label use of antipsychotics in general population sample

Author

Pirhonen, E. (Eero), Haapea, M. (Marianne), Rautio, N. (Nina), Nordström, T. (Tanja), Turpeinen, M. (Miia), Laatikainen, O. (Outi), Koponen, H. (Hannu), Silvan, J. (Jenni), Miettunen, J. (Jouko), Jääskeläinen, E. (Erika), Pirhonen, E. (Eero), Haapea, M. (Marianne), Rautio, N. (Nina), Nordström, T. (Tanja), Turpeinen, M. (Miia), Laatikainen, O. (Outi), Koponen, H. (Hannu), Silvan, J. (Jenni), Miettunen, J. (Jouko), and Jääskeläinen, E. (Erika)

Abstract

Objective: Increasing number of people have been prescribed antipsychotics (APs) off-label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off-label. Methods: The study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data. Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off-label (n = 137), individuals with non-psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off-label and the comparison groups using logistic regression. Results: The most common diagnoses in the off-label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non-psychotic mental disorders who were not prescribed APs off-label, individuals with prescribed off-label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off-label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. Conclusions: Individuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non-psychotic mental disorders who did not use APs.

Published
2022

8. Implementation of a new Digi-HTA process for digital health technologies in Finland

Author

Haverinen, J. (Jari), Turpeinen, M. (Miia), Falkenbach, P. (Petra), Reponen, J. (Jarmo), Haverinen, J. (Jari), Turpeinen, M. (Miia), Falkenbach, P. (Petra), and Reponen, J. (Jarmo)

Abstract

Objectives: There has been a lack of health technology assessment (HTA) methods for novel digital health technologies (DHTs) such as mHealth, artificial intelligence, and robotics in Finland. The Digi-HTA method has been developed for this purpose. The aim of this study is to determine whether it would be possible to use Digi-HTA recommendations to support healthcare decision-makers. Secondly, from the perspective of companies offering different types of DHT products, this study assesses the suitability of using the Digi-HTA framework to perform HTAs for their products. Methods: Feedback about Digi-HTA recommendations was collected from healthcare professionals. DHT companies provided input about the Digi-HTA framework. Data were collected via a web-based survey and were analyzed using qualitative methods. Results: Of the twenty-four healthcare professional respondents, twenty said that the Digi-HTA recommendations contained all the necessary information, and twenty-one found them useful for their work. Respondents hoped that the Digi-HTA recommendations would be better integrated into the decision-making processes and healthcare professionals would be more informed about this new HTA process. The questions of the Digi-HTA framework were applicable for different DHT products based on the responses from DHT companies (n = 8). Conclusions: According to the study participants, although the Digi-HTA recommendations include clear and beneficial information, their integration into healthcare decision-making processes should be improved. Responses from DHT companies indicate that the Digi-HTA framework would be an appropriate tool for performing assessments for their products. To generalize the findings of this study, more comprehensive studies will be needed.

Published
2022

9. Kuvantamisen potilasturvallisuus:vaara-, haitta- ja läheltä piti -tilanteet Suomen kuvantamiskeskuksissa

Author

Niinimäki, J. (Jaakko), Turpeinen, M. (Miia), Tarkiainen, T. (Tarja), Niinimäki, J. (Jaakko), Turpeinen, M. (Miia), and Tarkiainen, T. (Tarja)

Abstract

There is a possibility of harm associated with all human activity. Adverse events in imaging are related to the radiation equipment’s, image interpretation and various other aspects of the imaging process. Adverse events in imaging occur infrequently compared to the number of examinations however the effect on the patient may be substantial. The purpose of this study was to form a vision of the harmful incidents related to imaging by analysing how frequently adverse events, harms and near misses occur in Finnish public and private health care imaging units. The research material consisted of statistics obtained from three different authorities. The data of the Radiation and Nuclear Safety Authority consisted of 293 reports of adverse events of radiological examinations and measures. The statistics of the Patient Insurance Center included 1054 injury claims made by patients. In addition, the third data consisted of 7287 claims made by healthcare personnel to the electronic patient safety incident reporting system. The highest incidence of unnecessary or excessive radiation occurred in computed tomography (CT) scans. Injury reports made by patients were mostly related to incorrect or delayed diagnosis. Of the adverse events reported by staff, 75% caused some degree of harm to the patient, and 25% were near misses. Supervisors rated the risks associated with the adverse event as low (47.7%), insignificant (35%), or tolerable (15.7%). Investigating imaging incidents is significant and useful. The information generated by the research can be utilized in the systematic reduction and prevention of incidents related to various imaging processes. The research will increase the national development of patient safety in Finnish healthcare in the future., Tiivistelmä Kaikessa inhimillisessä toiminnassa on mahdollisuus tapahtua vahinko. Lääkinnällisen kuvantamisen vaaratapahtumat liittyvät tutkimuksessa käytettävään säteilyyn, laitteisiin kuvantulkintaan ja muihin kuvantamisprosessin vaiheisiin. Kuvantamisen vaaratapahtumia on suhteellisen vähän (alle 4 %), mutta haitan vaikutus saattaa olla potilaalle suuri. Tämän tutkimuksen tarkoituksena oli muodostaa näkemys kuvantamiseen liittyvistä vaaratapahtumista analysoimalla Suomen julkisen ja yksityisen terveydenhoidon kuvantamisyksiköiden vaara-, haitta- ja läheltä piti -tapahtumia. Tutkimuksen aineisto koostui säteilyturvakeskuksen (293 kpl) ja potilasvakuutuskeskuksen (1054 kpl) aineistosta sekä asiakas- ja potilasturvallisuuskeskuksen hallinnoimista terveydenhuoltohenkilökunnan sosiaali- ja terveydenhuollon vaaratapahtumajärjestelmään tekemistä ilmoituksista (7287 kpl). Tutkimuksen perusteella tietokonetomografiatutkimuksissa (TT) tapahtui useimmin turhaan tai liialliseen säteilyyn liittyviä poikkeavia tilanteita. Potilaiden tekemät vahinkoilmoitukset liittyivät virheelliseen tai viivästyneeseen diagnostiikkaan. Henkilökunnan ilmoittamista vaaratapahtumista 75 % aiheutti potilaalle jonkin asteisen haitan ja 25 % oli läheltä piti -tilanteita. Esimiehet arvioivat haittatapahtumaan liittyneet riskit vähäisiksi (47,7 %), merkityksettömiksi (35 %) tai kohtalaisiksi (15,7 %). Tutkimus osoitti, että kuvantamisen potilasturvallisuuteen liittyvien vaaratilanteiden analysointi on tarpeellista. Tutkimuksen tuottamaa tietoa voidaan hyödyntää kuvantamisen eri prosesseihin liittyvien vaaratapahtumien suunnitelmallisessa vähentämisessä ja ennaltaehkäisyssä. Tutkimus lisää Suomen terveydenhuollon potilasturvallisuuden kansallista kehitystä tulevaisuudessa.

Published
2022

10. Detecting patient safety errors by characterizing incidents reported by medical imaging staff

Author

Tarkiainen, T. (Tarja), Sami Sneck, S. S. (Sami Sneck), Haapea, M. (Marianne), Turpeinen, M. (Miia), Niinimäki, J. (Jaakko), Tarkiainen, T. (Tarja), Sami Sneck, S. S. (Sami Sneck), Haapea, M. (Marianne), Turpeinen, M. (Miia), and Niinimäki, J. (Jaakko)

Abstract

The objectives of the study were to characterize events related to patient safety reported by medical imaging personnel in Finland in 2007–2017, the number and quality of reported injuries, the risk assessment, and the planned improvement of operations. The information was collected from a healthcare patient safety incident register system. The data contained information on the nature of the patient safety errors, harms and near-misses in medical imaging, the factors that lead to the events, the consequences for the patient, the level of risks, and future measures. The number of patient safety incident reports included in the study was 7,287. Of the incident reports, 75% concerned injuries to patients and 25% were near-misses. The most common consequence of adverse events and near-misses were minor harm (37.2%) related to contrast agent, or no harm (27.9%) related to equipment malfunction. Supervisors estimated the risks as low (47.7%) e.g., data management, insignificant (35%) e.g., verbal communication or moderate (15.7%) e.g., the use of contrast agent. The most common suggestion for learning from the incident was discussing it with the staff (58.1%), improving operations (5.7%) and submitting it to a higher authority (5.4%). Improving patient safety requires timely, accurate and clear reporting of various patient safety incidents. Based on incident reports, supervisors can provide feedback to staff, develop plans to prevent accidents, and monitor the impact of measures taken. Information on the development of occupational safety should be disseminated to all healthcare professionals so that the same mistakes are not repeated.

Published
2022

11. Medication-related adverse events in health care—what have we learned?:a narrative overview of the current knowledge

Author

Laatikainen, O. (O.), Sneck, S. (S.), Turpeinen, M. (M.), Laatikainen, O. (O.), Sneck, S. (S.), and Turpeinen, M. (M.)

Abstract

Purpose: Although medication-related adverse events (MRAEs) in health care are vastly studied, high heterogeneity in study results complicates the interpretations of the current situation. The main objective of this study was to form an up-to-date overview of the current knowledge of the prevalence, risk factors, and surveillance of MRAEs in health care. Methods: Electronic databases (PubMed, MEDLINE, Web of Science, and Scopus) were searched with applicable search terms to collect information on medication-related adverse events. In order to obtain an up-to-date view of MRAEs, only studies published after 2000 were accepted. Results: The prevalence rates of different MRAEs vary greatly between individual studies and meta-analyses. Study setting, patient population, and detection methods play an important role in determining detection rates, which should be regarded while interpreting the results. Medication-related adverse events are more common in elderly patients and patients with lowered liver or kidney function, polypharmacy, and a large number of additional comorbidities. However, the risk of MRAEs is also significantly increased by the use of high-risk medicines but also in certain care situations. Preventing MRAEs is important as it will decrease patient mortality and morbidity but also reduce costs and functional challenges related to them. Conclusions: Medication-related adverse events are highly common and have both immediate and long-term effects to patients and healthcare systems worldwide. Conclusive solutions for prevention of all medication-related harm are impossible to create. In the future, however, the development of efficient real-time detection methods can provide significant improvements for event prevention and forecasting.

Published
2022

13. Budesonide improves decreased airway conductance in infants with respiratory symptoms

Author

Pelkonen, A.S., Malmstrom, K., Malmberg, L.P., Sarna, S., Turpeinen, M., Kajosaari, M., Haahtela, T., and Makela, M.J.

Subjects
Budesonide -- Usage, Budesonide -- Health aspects, Respiratory tract diseases -- Drug therapy, Respiratory tract diseases -- Patient outcomes, Drug therapy -- Usage, Drug therapy -- Patient outcomes, Children -- Diseases, Children -- Drug therapy, Children -- Patient outcomes
Published
2009

15. Satunnaistamisen arvo

Author

Tenhunen, O. (Olli) and Turpeinen, M. (Miia)

Subjects
satunnaistetut kontrolloidut tutkimukset aiheena, satunnaistaminen, kliiniset kokeet aiheena
Published
2021

16. DPYD-geenitestaus kliinisessä käytössä

Author

Saarenheimo, J. (Jatta), Wahid, N. (Nesna), Tornio, A. (Aleksi), Ristamäki, R. (Raija), Keinänen, M. (Mauri), Niemi, M. (Mikko), Turpeinen, M. (Miia), and Jekunen, A. (Antti)

Abstract

Tiivistelmä Eri syöpien hoidossa laajasti käytettyihin fluoropyrimidiini-lääkkeisiin (kapesitabiini, tegafuuri ja 5-fluorourasiili) liittyy vakavien haittavaikutusten mahdollisuus. Niistä tyypillisimpiä ovat ripuli, suun ja suolen limakalvojen haavaumat, luuydinlama, hermotoksisuus sekä sydänhaitat. Yksi syy haittoihin on dihydropyrimidiinidehydrogenaasi-entsyymin (DPD) vajaus ja toimimattomuus, joka johtaa fluorourasiilin aineenvaihduntahäiriöön ja kertymiseen elimistöön. Vuonna 2020 Euroopan lääkevirasto (EMA) antoi suosituksen, jonka mukaan DPD-entsyymin toimimattomuus tulee selvittää ennen fluoropyrimidiinien antamista. Testaus voidaan tehdä tutkimalla potilaan verinäytteestä tunnettuja kliinisesti merkittäviä DPYD-geenivariantteja. Fluoropyrimidiinejä ei tule antaa potilaalle ollenkaan, mikäli hänellä todetaan täydellinen DPD-entsyymin puutos. Osittaisessa DPD-entsyymin puutostilassa hoito aloitetaan pienennetyllä annoksella, mikä pohjautuu kansainvälisiin annossuosituksiin.

Published
2021

17. Investigating errors in medical imaging:medical malpractice cases in Finland

Author

Tarkiainen, T. (Tarja), Turpeinen, M. (Miia), Haapea, M. (Marianne), Liukkonen, E. (Esa), and Niinimäki, J. (Jaakko)

Subjects
Adverse events, Patient injury claim, Incident reporting, Safety error
Abstract

Objective: The objectives of the study were to survey patient injury claims concerning medical imaging in Finland in 1991–2017, and to investigate the nature of the incidents, the number of claims, the reasons for the claims, and the decisions made concerning the claims. Materials and methods: The research material consisted of patient claims concerning imaging, sent to the Finnish Patient Insurance Centre (PVK). The data contained information on injury dates, the examination code, the decision code, the description of the injury, and the medical grounds for decisions. Results: The number of claims included in the study was 1054, and the average number per year was 87. The most common cause was delayed diagnosis (404 claims, 38.3%). Most of the claims concerned mammography (314, 29.8%), radiography (170, 16.1%), and MRI (162, 15.4%). According to the decisions made by the PVK, there were no delays in 54.6% of the examinations for which claims were made. About 30% of all patient claims received compensation, the most typical reason being medical malpractice (27.7%), followed by excessive injuries and injuries caused by infections, accidents and equipment (2.7%). Conclusion: Patient injury in imaging examinations and interventions cannot be completely prevented. However, injury data are an important source of information for health care. By analysing claims, we can prevent harm, increase the quality of care, and improve patient safety in medical imaging.

Published
2021

18. Uusien sairaalalääkkeiden hallitun käyttöönoton sopimukset:maksajan näkökulma

Author

Ajosenpää, M. (Minna), Huupponen, R. (Risto), Turpeinen, M. (Miia), and Rannanheimo, P. (Piia)

Subjects
hospital-only medicinal products, managed entry, sairaalalääkkeet, Risk-sharing agreement, medicine costs, lääkekustannukset, riskinjakosopimus, hallittu käyttöönotto
Abstract

Tiivistelmä Johdanto: Markkinoille tulevien uusien lääkkeiden hinnat haastavat terveydenhuoltojärjestelmän taloudellisen kantokyvyn. Uuden lääkkeen käyttöönottoon liittyy aina epävarmuutta, kun lääkkeen käyttö siirtyy tutkimusolosuhteista todelliseen elämään. Haasteita on pyritty ratkomaan sairaanhoitopiireissä niin sanotuilla hallitun käyttöönoton sopimuksilla. Ne ovat maailmalla yleisiä ja ovat todennäköisesti yleistymässä myös Suomessa. Tämän tutkimuksen tavoitteena oli kartoittaa sopimusten nykytilannetta Suomessa, tutkia sopimuksiin liittyviä maksajapuolen näkemyksiä ja tunnistaa käytännön toteutukseen liittyviä maksajapuolen tarpeita. Menetelmät: Tutkimus toteutettiin anonyyminä kyselytutkimuksena elokuussa 2020. Kysely sisälsi sekä avoimia että strukturoituja kysymyksiä. Kohderyhmänä oli uusien kalliiden sairaalalääkkeiden käyttöönottopäätöksiin osallistuvat ammattihenkilöt Suomen yliopistosairaanhoitopiireissä. Strukturoituihin kysymyksiin saadut vastaukset koottiin aineistoa kuvaileviksi lukumäärätiedoiksi ja prosenttiosuuksiksi. Avoimiin kysymyksiin saadut vastaukset käsiteltiin soveltamalla aineistolähtöistä sisällönanalyysiä ja kvantifiointia. Tulokset: Hallitun käyttöönoton sopimus oli käsitteenä tuttu lähes kaikille vastaajille (n = 29). Useita sopimuksia oli vastaushetkellä yliopistosairaanhoitopiireissä voimassa. Osa sopimuksista oli taloudellisia sopimuksia ja osa vaikuttavuusperusteisia sopimuksia. Eniten sopimuksia oli solmittu liittyen syöpälääkkeisiin ja immuunivasteen muuntajiin (ATC-ryhmä L). Sairaanhoitopiireissä tarvitaan sopimuksiin liittyen erityistä osaamista, asiantuntijapanosta ja resursseja. Erityisesti juridisen osaamisen tarve korostui. Riskinjakosopimusten hyötynä mainittiin useimmin kustannussäästöt sekä kustannusriskin jakaminen lääkeyrityksen ja lääkettä käyttävän organisaation välillä. Negatiivisina asioina useimmin mainittiin sopimuksista maksajapuolelle aiheutuva lisätyö, sekä hintojen luottamuksellisuus ja siitä johtuva läpinäkyvyyden puute. Suurin osa vastaajista kannatti riskinjakosopimusten solmimista kansallisella tasolla pääasiassa potilaiden alueellisen tasa-arvoisuuden vuoksi. Vastaajista suurin osa piti terveydenhuollon palveluvalikoimaneuvoston suosituksia hyödyllisinä riskinjakosopimuksista neuvoteltaessa. Johtopäätökset: Uusien lääkkeiden riskinjakosopimukset ovat Suomessa sairaalapuolella jo arkipäivää. Parhaimmillaan sopimukset voivat hyödyttää kumpaakin osapuolta uusien kalliiden sairaalalääkkeiden käyttöönottoon liittyvän epävarmuuden hallinnassa, mutta maksajapuolen näkökulmasta sopimuksiin liittyy myös monia haasteita. Sopimusneuvottelujen kehittäminen kansalliseen suuntaan on oikea tie, mutta maksajapuolen asemaa tulisi vahvistaa myös muilla tavoin. Sopimusten luottamuksellisuutta tulisi höllentää. Maksajapuolella tulisi varmistaa sopimusten hallintaan liittyvät riittävät resurssit, lisätä tavoitteellisuutta ja strategista otetta sekä kehittää tietojärjestelmiä ja tiedonhallintaa. Lisätutkimusta tarvitaan maksajapuolen näkökulmasta sopimusten todellisista hyödyistä ja tavoitteiden täyttymisestä sekä niiden suhteesta sopimusten vaatimiin resursseihin, jotta maksajapuolen resursseja voidaan kohdentaa saavutettavissa olevien hyötyjen kannalta tehokkaasti. Summary Introduction: The high prices of new medicines are challenging the financial sustainability of healthcare systems. There is always uncertainty when a new medication emerges from research conditions into real-life use. These challenges have encouraged the adoption of managed entry agreements (MEA) around the world. Such agreements are becoming more common in Finland as well. This study sought to map out the current situation of these agreements in Finland and to explore and identify payer views and needs concerning these agreements. Materials and methods: The study was conducted as an anonymous survey in August 2020. The survey consisted of open-ended questions as well as structured questions. The target group of this survey were the professionals who are part of the decision-making process in prescribing or purchasing new, expensive medications in the University Hospital Districts of Finland. The results were compiled as quantities and percentages to describe the data (structured questions) or processed by applying inductive content analysis and quantification (open-ended questions). Results: Most of the respondents (n = 29) were familiar with the concept of a managed entry agreement. At the time of the survey, there were many such agreements already in force in the University Hospital Districts concerned. Some were financial agreements, others performance-based. On average, more than half of the agreements concerned the ATC group L. The hospital districts need special expertise from and cross-disciplinary cooperation between many different professionals to manage the agreements. When asked about the benefits of the agreements, respondents mentioned cost savings and risk sharing most often. The most common negative aspects mentioned were the extra workload imposed on the payer and a lack of transparency due the confidentiality of the agreements. Most of the respondents preferred agreements to be concluded at the national level rather than the regional level, mostly on grounds of equality. Most of the respondents found the Council for Choices in Health Care in Finland (COHERE Finland, “Palko”) recommendations useful when negotiating the agreements. Conclusions: Today, Finnish hospitals commonly make use of managed entry agreements when acquiring new medications. Such agreements may be beneficial to both parties (industry and payer) to stave off uncertainty when introducing new medical products, but from the payers’ point of view many challenges remain to be solved as well. Moving the agreement process entirely from the regional level to the national would be a useful step, but not a sufficient one. The confidentiality built into the agreements should be loosened. The payer side must ensure the provision of adequate resources and competence in managing agreements, and information systems and data management should be improved. The payer side must adopt a more strategic and goal-oriented approach. More research is needed about the real benefits of the agreements, contrasted to the resources their management demands on the payer side, to make sure the payers are using their resources appropriately in concluding these agreements.

Published
2021

25. CYP-associated drug–drug interactions:a mission accomplished?

Author

Pelkonen, O. (Olavi), Hakkola, J. (Jukka), Hukkanen, J. (Janne), and Turpeinen, M. (Miia)

Subjects
enzymes and coenzymes (carbohydrates), drug-drug interactions, organic chemicals, CYP, heterocyclic compounds, Cytochrome P450, approved drugs, respiratory system, urologic and male genital diseases
Abstract

On the basis of official Finnish Medicines Authority (Fimea)-approved drug monographs, less than half of the approved small-molecule drugs between 2007 and 2016 were substrates, inhibitors or inducers of CYP enzymes, predominantly of CYP3A4. No significant unexpected, life-threatening, CYP-associated drug-drug interactions (CYP-DDIs) of newly approved drug entities have been observed in the last 10–15 years. The present analysis seems to suggest that tools to study and predict potentially significant CYP-DDIs are working and efficient.

Published
2020

27. The risks and outcomes resulting from medication errors reported in the Finnish tertiary care units:a cross-sectional retrospective register study

Author

Laatikainen, O. (Outi), Sneck, S. (Sami), and Turpeinen, M. (Miia)

Subjects
medication error, pharmaceutical care, patient safety, medication safety, tertiary care
Abstract

Background: Hospital-acquired medication errors (MEs) are common in health care. Although voluntary reporting is criticized for not producing reliable estimates on ME frequency, it provides valuable knowledge on errors occurring in the medication process. Objective: The purpose of this study was to analyze and determine the risks and outcomes resulting from MEs related to the TOP15 medicines in the Finnish tertiary care units from July 2016 to July 2017. Methods: The data consisting of 1,447 ME reports was organized according to ATC classification, after which TOP15 medicines involved in the reports were selected. Inductive content analysis was performed to the reports. After this, the reports were categorized by ME outcome into five categories and further analyzed accordingly. Results: The most common ME outcome in the reports was “omitted medicine” (33.9%). More than a quarter (27.1%) of ME reports were estimated to cause moderate or severe risk to the patient. When compared with each other, none of the outcome groups were more susceptible to high-risk events (p = 0.71). Of the TOP15 medicines, only Norepinephrine had significantly higher risk of being involved in high-risk events (OR 2.43, 95%CI 1.35–4.61). Conclusion: Voluntary reporting has an important role in the development of medication safety and the overall medication process within organizations. Although majority of the TOP15 medicines were involved in MEs resulting in seemingly high-risk outcomes, they were estimated to be insignificant or minor within the reporting unit. In the future, more emphasis will be needed for the assessment and analysis of the reports for more efficient, real-time detection and response to signals from health care units.

Published
2020

29. Lääkkeisiin liittyviä haittatapahtumia ehkäistään tiedolla

Author

Laatikainen, O. (Outi) and Turpeinen, M. (Miia)

Abstract

Tiivistelmä Jopa joka viides sairaalapotilas saa vakavan lääkehaitan. Korkea ikä ja monilääkehoito lisäävät riskiä. Virheitä tapahtuu erityisesti lääkkeiden määräämisessä ja annostelussa.

Published
2020

33. Inhibition and induction of CYP enzymes in humans:an update

Author

Hakkola, J. (Jukka), Hukkanen, J. (Janne), Turpeinen, M. (Miia), Pelkonen, O. (Olavi), Hakkola, J. (Jukka), Hukkanen, J. (Janne), Turpeinen, M. (Miia), and Pelkonen, O. (Olavi)

Abstract

The cytochrome P450 (CYP) enzyme family is the most important enzyme system catalyzing the phase 1 metabolism of pharmaceuticals and other xenobiotics such as herbal remedies and toxic compounds in the environment. The inhibition and induction of CYPs are major mechanisms causing pharmacokinetic drug–drug interactions. This review presents a comprehensive update on the inhibitors and inducers of the specific CYP enzymes in humans. The focus is on the more recent human in vitro and in vivo findings since the publication of our previous review on this topic in 2008. In addition to the general presentation of inhibitory drugs and inducers of human CYP enzymes by drugs, herbal remedies, and toxic compounds, an in-depth view on tyrosine-kinase inhibitors and antiretroviral HIV medications as victims and perpetrators of drug–drug interactions is provided as examples of the current trends in the field. Also, a concise overview of the mechanisms of CYP induction is presented to aid the understanding of the induction phenomena.

Published
2020

34. Single‐arm clinical trials as pivotal evidence for cancer drug approval:a retrospective cohort study of centralized European marketing authorizations between 2010 and 2019

Author

Tenhunen, O. (Olli), Lasch, F. (Florian), Schiel, A. (Anja), Turpeinen, M. (Miia), Tenhunen, O. (Olli), Lasch, F. (Florian), Schiel, A. (Anja), and Turpeinen, M. (Miia)

Abstract

The traditional drug development paradigm, consisting of sequential phases and randomized studies, has been challenged in oncology and hemato‐oncology. In the regulatory context, a number of new products have been authorized based on nonrandomized efficacy and safety data. We retrospectively analyzed the European public assessment reports for anticancer treatments authorized between 2010 and 2019 to describe the data behind such approvals. Twenty‐two initial marketing authorizations, mainly conditional, were identified. Fifty percent of the products had an orphan indication, and 77% had received previous scientific advice. Conclusions of clinical benefit were based on tumor responses, ranging between 15.8 and 88%. Our data shows that single‐arm clinical studies leading to positive regulatory outcomes share common methodological approaches and end points, mostly comparing the overall response rate with a fixed success threshold as the primary analysis. The clinical indications in these approvals are clustered in late‐line settings, hematological malignancies, and lung cancer. Our findings underline the need to reflect on the current practice, the methodological aspects, and end points in single‐arm studies, and develop specific regulatory guidance on nonrandomized and novel study designs.

Published
2020

35. Adverse events due to unnecessary radiation exposure in medical imaging reported in Finland

Author

Tarkiainen, T. (T.), Haapea, M. (M.), Liukkonen, E. (E.), Tervonen, O. (O.), Turpeinen, M. (M.), Niinimäki, J. (J.), Tarkiainen, T. (T.), Haapea, M. (M.), Liukkonen, E. (E.), Tervonen, O. (O.), Turpeinen, M. (M.), and Niinimäki, J. (J.)

Abstract

Introduction: Adverse events in radiology are quite rare, but they do occur. Radiation safety regulations and the law obligate organizations to report certain adverse events, harm and near misses, especially events related to patients’ health and safety. The aim of this study was to describe and analyse incidents related to radiation safety issues reported in Finland. Methods: The data were collected from incident reports documented by radiology personnel concerning notifications of abnormal events in medical imaging made to the Radiation and Nuclear Safety Authority between 2010 and 2017. During these eight years, 312 reports were submitted. Only events reported from radiology departments were included; nuclear medicine, radiotherapy and animal radiology cases were excluded. The final number of reports was 293 (94%). Results: The majority of the 293 approved reports were related to computed tomography (CT, 68.3%) and to X-ray examinations (27.6%). Altogether 82.9% of those irradiated were adults, most of whom were exposed to unnecessary radiation through CT (86.5%), 5.5% were children, and 4.4% pregnant women. The most common effective dose of unnecessary radiation was 1 mSv or less (89.7% of all examinations). The highest effective doses were reported in CT (from under 1 mSv–20 mSv and above). The reasons for the adverse events were incorrect identification (32%), incorrect procedure, site or side (30%); and human errors or errors of knowledge (20%). Conclusion: Adverse events occurred especially in CT examinations. It is important to collect and analyse incident data, assess the harmful events, learn from them and aim to reduce adverse events. Implications for practice: This study emphasizes the need for radiological personnel to obtain evidence-based information on adverse events and focus on training to improve patient safety.

Published
2020

36. Medication-related adverse events in health care

Author

Turpeinen, M. (Miia), Sneck, S. (Sami), Laatikainen, O. (Outi), Turpeinen, M. (Miia), Sneck, S. (Sami), and Laatikainen, O. (Outi)

Abstract

Medication-related adverse events include adverse drug events either directly or indirectly related to the drug’s pharmacology, as well as medication errors, i.e. errors in the medication process. Medication-related adverse events are common issue in both the inpatient and outpatient setting affecting approximately 20% of hospitalized patients and causing 3–5% of unplanned hospital admissions in the adult population. Although medication-related adverse events are common in all age groups, geriatric patients have been found especially susceptible to them. With the estimates of increased life expectancy and higher consumption of medicines in the future, there has been a growing pressure for more efficient detection and prevention of medication-related adverse events. The objective of this study was to form a comprehensive overview of medication-related adverse events around the Finnish tertiary care by describing both adverse drug events and medication errors occurring in this setting. The results of this research project demonstrated that adverse drug events affect approximately every fifth patient during hospital admission and that one third of these events are preventable. Most of adverse drug events and medication errors occur with medicines from commonly used ATC groups, the largest group being the N (Nervous class) medicines. Medication-related adverse events were also identified as a burdening factor to the health care organizations, as it was estimated that 23% of the unplanned geriatric hospital admissions resulted from adverse drug events. This research project was the first to describe the overall situation of medication-related adverse events in the Finnish tertiary care by utilizing the national medication safety incident report (Haipro) data. It emphasized the importance of medication safety research in the development of adverse event detection and prevention methods. The results of this research project create opportunities for further develop, Tiivistelmä Lääkkeisiin liittyviin haittatapahtumiin luetaan sekä lääkkeen farmakologiaan suorasti tai epäsuorasti liittyvät lääkehaitat, että lääkehoidon prosessin virheinä ilmenevät lääkityspoikkeamat. Lääkehaitat ja lääkityspoikkeamat ovat yleinen ongelma niin sairaaloissa kuin avohoidon puolellakin koskettaen arviolta 20 % sairaalassa hoidetuista potilaista ja aiheuttaen arviolta 3–5 % kaikista aikuisväestön päivystyskäynneistä. Vaikka lääkehaittoja esiintyy yleisesti koko väestön tasolla, ovat iäkkäät potilaat niille erityisen alttiita. Väestön ikärakenteen muutos sekä lääkkeiden kasvava kulutus luovat paineita lääkkeisiin liittyvien haittatapahtumien entistä tehokkaammalle tunnistamiselle ja ennaltaehkäisylle tulevaisuudessa. Tämän työn tarkoituksena oli muodostaa kokonaiskäsitys lääkkeisiin liittyvistä haittatapahtumista kuvaamalla sekä lääkehaittojen että lääkityspoikkeamien ilmenemistä erikoissairaanhoidon ympärillä. Työssä lääkehaittoja havaittiin arviolta joka viidennellä erikoissairaanhoidossa hoidetulla potilaalla. Kolmasosa lääkehaitoista arvioitiin ennaltaehkäistäviksi. Suurin osa lääkehaittoihin ja lääkityspoikkeamiin osallistuneista lääkkeistä kuului viiteen yleisesti käytettyyn ATC-ryhmään, joista useimmiten edustettuna olivat keskushermoston kautta vaikuttavat lääkeaineet (N-ryhmän lääkkeet). Lääkehaittojen havaittiin aiheuttavan merkittävää kuormitusta erikoissairaanhoidossa aiheuttamalla arviolta 23 % iäkkäiden päivystyskäynneistä. Tämä väitöskirjatutkimus kuvasi lääkehaittoja suomalaisessa erikoissairaanhoidossa ensimmäisen kerran kansallista Haipro-aineistoa hyödyntäen. Tutkimuksessa osoitettiin lääkkeisiin liittyviin haittoihin kohdistuvan tutkimuksen ja tiedon tärkeys sekä seurantaa että ennaltaehkäiseviä prosesseja suunniteltaessa. Tämän väitöskirjaprojektin tutkimus luo pohjaa sekä lääkitysturvallisuuden että potilasturvallisuuden kansalliselle kehitykselle suomalaisissa terveydenhuollon organisaatioissa.

Published
2020

43. Fiktionkirjoittajien tiedonhankintakäyttäytyminen

Author

Turpeinen, M. (Milja)

Abstract

Tiivistelmä. Tämän tutkimuksen tarkoituksena on selvittää fiktionkirjoittajien yleisimpiä tiedonhankintastrategioita, todennäköisempiä tiedonlähteitä, sekä miksi he valitsivat käyttämänsä strategiat ja tiedonlähteet. Lisäksi olen kiinnostunut siitä miksi taustatutkimus koetaan tärkeäksi fiktionkirjoittamisessa. Lähestymistapa on laadullinen, ja aineiston keräämiseksi haastattelin neljää harrastajafiktionkirjoittajaa heidän tiedonhankintatavoistaan puolistrukturoidulla haastattelurungolla.

Published
2019

44. Kirurginen savu toimenpiteissä:henkilöstön riskit ja suojaus

Author

Lankinen, P. (Petteri), Parkkila, A.-K. (Anna-Kaisa), Roine, R. P. (Risto P.), and Turpeinen, M. (Miia)

Abstract

Tiivistelmä Monia sähkökirurgisia instrumentteja käytettäessä syntyy kirurgista savua. Henkilöstö voi altistua kumulatiivisesti savun haitallisille komponenteille. Tavallinen kirurginen hengityssuojain antaa yli 90-prosenttisen suojan. Lisäksi tulisi käyttää asianmukaisella suodattimella varustettua paikallista savunpoistolaitteistoa. Savulle altistumisen ei ole osoitettu lisäävän sairastavuutta tai syöpäriskiä. Abstract In this article, we review the evidence on potential hazards of surgical smoke. The purpose is to review the literature and summarize current recommendations for protection against hazards of surgical plume. Operating room personnel are exposed to various hazardous substances and radiation in their work, and the cumulative exposure may lead to increased risk of adverse health events. Due to the possible occupational health and safety risk there is a growing interest in identifying the composition of surgical smoke and the necessary protective measures. Surgical smoke is formed when electrosurgical instruments are used in cutting and coagulating. The composition and the amount of surgical smoke produced vary. The factors influencing the formation of surgical plume include the type of surgery, the target tissue and its pathology, the type of instrument used and the amount of cutting and coagulating performed. Surgical smoke is composed of gases and vapours, as well as particles of biological origin, including potentially viable pathogens. In addition, surgical smoke contains ultrafine particles which may deposit in the respiratory tract. Although there is currently no evidence that exposure to surgical smoke causes increased morbidity and mortality, attention to potential hazards of surgical smoke is warranted. General room ventilation and the use of room suction units, primarily designed for capture of liquids, are not sufficient alone to control more substantial exposure to hazards of surgical smoke. The most effective way to control exposure to surgical smoke is to remove smoke at the surgical site using local exhaust ventilation (LEV). Personal filtration masks, such as surgical masks and high filtration masks, are efficient and their use alongside LEV systems is recommended.

Published
2019

45. Drugs used for neurologic and psychiatric conditions increase the risk for bullous pemphigoid:a case-control study

Author

Varpuluoma, O. (Outi), Jokelainen, J. (Jari), Försti, A.-K. (Anna-Kaisa), Turpeinen, M. (Miia), Timonen, M. (Markku), Huilaja, L. (Laura), and Tasanen, K. (Kaisa)

Subjects
integumentary system
Abstract

To the Editor: The association between neurologic diseases and bullous pemphigoid (BP) is well established.1 However, it has not yet been established whether drugs that affect the nervous system can influence the onset of BP. The aim of this study was to determine if patients who receive drugs to treat neurologic and psychiatric diseases have an altered risk for BP.

Published
2019

46. Look alike, sound alike:lääkkeet lääkityspoikkeamien aiheuttajina

Author

Laatikainen, O. (Outi), Sneck, S. (Sami), and Turpeinen, M. (Miia)

Abstract

Tiivistelmä Look alike, sound alike -lääkkeet (LASA-lääkkeet, näköisnimiset lääkkeet) ovat lääkevalmisteita, joilla on kohonnut riski sekoittua keskenään samankaltaisen pakkauksen, valmistenimen tai vaikuttavan aineen nimen vuoksi. Merkittävä osuus lääkityspoikkeamista johtuu LASA-lääkkeistä.

Published
2019

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